Common use of Enrollment and Disenrollment Processes Clause in Contracts

Enrollment and Disenrollment Processes. Under passive enrollment, eligible individuals will be notified of their right to select among contracted Participating Plans no fewer than sixty (60) days prior to the effective date of enrollment, and will have the opportunity to opt out until the last day of the month prior to the effective date of enrollment. When no active choice has been made, enrollment into a Participating Plan may be conducted using a seamless, passive enrollment process that provides the opportunity for beneficiaries to make a voluntary choice to enroll or disenroll from the Participating Plan at any time. Prior to the effective date of their enrollment, individuals who would be passively enrolled will have the opportunity to opt out and will receive sufficient notice and information with which to do so, as further detailed in Appendix 7. Disenrollment from Participating Plans and transfers between Participating Plans shall be allowed on a month-to-month basis any time during the year; however, coverage for these individuals will continue through the end of the month. CMS and DMAS will monitor enrollments and disenrollments for both evaluation purposes and for compliance with applicable marketing and enrollment laws, regulations and CMS policies, for the purposes of identifying any inappropriate or illegal marketing practices. As part of this analysis, CMS and DMAS will monitor any unusual shifts in enrollment by individuals identified for passive enrollment into a particular Participating Plan to a Medicare Advantage plan operated by the same parent organization. If those shifts appear to be due to inappropriate or illegal marketing practices, CMS and DMAS may issue corrective action. Any illegal marketing practices will be referred to appropriate agencies for investigation. As mutually agreed upon, and as discussed further in Appendix 7 and the three-way contract, CMS and DMAS will utilize an independent third party entity to facilitate all enrollments into the Participating Plans. Participating Plan enrollments, transfers, and opt-outs shall become effective on the same day for both Medicare and Medicaid (the first day of the following month). For those who lose Medicaid eligibility during the month, coverage and Federal financial participation will continue through the end of that month.

Enrollment and Disenrollment Processes. Under this Demonstration, enrollment for eligible beneficiaries into a MMIP may be conducted – when no active choice has otherwise been made – using a seamless, passive enrollment process that provides the opportunity for beneficiaries to make a voluntary choice to enroll or disenroll from the MMIP at any time. Under passive enrollment, eligible individuals will be notified of plan selection and of their right to select among other contracted Participating Plans MMIPs no fewer than sixty (60) days prior to the effective date of enrollment, and will have the opportunity to opt out until the last day of the month prior to the effective date of enrollment. When no active choice has been made, enrollment into a Participating Plan may be conducted using a seamless, passive enrollment process that provides the opportunity for beneficiaries to make a voluntary choice to enroll or disenroll from the Participating Plan at any time. Prior to the effective date of their enrollment, individuals who would be passively enrolled will have the opportunity to opt out and will receive sufficient notice and information with which to do so, as further detailed in Appendix 7. If a choice to enroll in a MMIP is made by the second to the last business day of the month, enrollment will be effective the first calendar day of the following month. Disenrollment from Participating Plans MMIPs and transfers between Participating Plans enrollment from one MMIP to a different MMIP shall be allowed on a month-to-month basis any time during the year; however, coverage for these individuals . All disenrollments will continue through be effective the end first day of the monthmonth after the choice is made. CMS and DMAS will monitor enrollments and disenrollments for both evaluation purposes and for compliance with applicable marketing and MMIP enrollments, including enrollment laws, regulations and CMS policies, for the purposes of identifying any inappropriate or illegal marketing practices. As part of this analysis, CMS and DMAS will monitor any unusual shifts in enrollment by individuals identified for passive enrollment into a particular Participating Plan from one MMIP to a Medicare Advantage plan operated by the same parent organization. If those shifts appear to be due to inappropriate or illegal marketing practices, CMS and DMAS may issue corrective action. Any illegal marketing practices will be referred to appropriate agencies for investigation. As mutually agreed upon, and as discussed further in Appendix 7 and the three-way contract, CMS and DMAS will utilize an independent third party entity to facilitate all enrollments into the Participating Plans. Participating Plan enrollments, transfersdifferent MMIP, and opt-outs shall become effective on the same day for both Medicare and Medicaid (the first day of the following month). For those who lose Medicaid eligibility during the month, coverage and Federal financial participation FFP will continue through the end of that month. See Appendix 7 for a more detailed discussion on timing of enrollments and disenrollments. CMS and the State will monitor enrollments and disenrollments for both evaluation purposes and for compliance with applicable marketing and enrollment laws, regulations and policies, for the purpose of identifying any inappropriate or illegal marketing practices. As part of this analysis, CMS and the State will monitor any unusual shifts in enrollment by individuals identified for passive enrollment into a particular MMIP to a Medicare Advantage Plan operated by the same parent organization. If those shifts appear to be due to inappropriate or illegal marketing practices, CMS and the State may issue corrective action. Any illegal marketing practices will be referred to appropriate agencies for investigation.

Enrollment and Disenrollment Processes. Under passive enrollment, eligible The Demonstration will begin with an opt- in period during which the enrollment will only be among those individuals who choose to participate. Eligible individuals will be notified of their right to select among contracted Participating Plans ICOs no fewer than sixty thirty (6030) days prior to the first effective date of enrollment. For eligible individuals who do not participate in the opt-in period – either by choosing an ICO or expressing a preference not to participate in the Demonstration – enrollment into an ICO may be conducted using a seamless, and passive enrollment process. Individuals eligible for passive enrollment will be notified no fewer than 60 days prior to the enrollment effective date of plan assignment, the opportunity to choose among ICOs, choose not to participate in the Demonstration, or choose to disenroll from an ICO at any time after enrollment. Prior to the effective date of their enrollment, beneficiaries who would be passively enrolled will have the opportunity to opt out until the last day of the month prior to the effective date of enrollment. When no active choice has been mademonth, enrollment into a Participating Plan may be conducted using a seamless, passive enrollment process that provides the opportunity for beneficiaries to make a voluntary choice to enroll or disenroll from the Participating Plan at any time. Prior to the effective date of their enrollment, individuals who would be passively enrolled will have the opportunity to opt out and will receive sufficient notice and information with which to do so, as further detailed in Appendix 7. Disenrollment from Participating Plans ICOs and transfers between Participating Plans enrollment from one ICO to a different ICO shall be allowed on a month-to-month basis any time during the year; however, coverage for these individuals will continue through the end of the month. CMS and DMAS MDCH will monitor enrollments and disenrollments for both evaluation purposes and for compliance with applicable marketing and enrollment laws, regulations regulations, and CMS policies, for the purposes of identifying any inappropriate or illegal marketing practices. As part of this analysis, CMS and DMAS MDCH will monitor any unusual shifts in enrollment by individuals identified for passive enrollment into a particular Participating Plan ICO to a Medicare Advantage plan operated by the same parent organization. If those shifts appear to be due to inappropriate or illegal marketing practices, CMS and DMAS MDCH may issue corrective actiondiscontinue further passive enrollment into an ICO. Any illegal marketing practices will be referred to appropriate agencies for investigation. As mutually agreed upon, and as discussed further in Appendix 7 and the three-way contract, CMS and DMAS MDCH will utilize an independent third party entity to facilitate all enrollments into the Participating PlansICOs. Participating Plan enrollments, transfers, and opt-outs shall become effective on the same day for both Medicare and Medicaid (the first day of the following month). For those who lose Medicaid eligibility during the month, coverage and Federal financial participation will continue through the end of that month.ICO

Enrollment and Disenrollment Processes. When no active choice has been made, enrollment for eligible beneficiaries (as described above in Section III.C.1) may be conducted using a seamless passive enrollment process that provides the opportunity for Enrollees to make a voluntary choice to enroll or disenroll from the CICO on a monthly basis. Under passive enrollment, eligible individuals will be notified of plan selection and of their right to select among other contracted Participating Plans CICOs no fewer than sixty (60) days prior to the effective date of enrollment, and will have the opportunity to opt out until the last day of the month prior to the effective date of enrollment. When no active choice has been made, enrollment into a Participating Plan may be conducted using a seamless, passive enrollment process that provides the opportunity for beneficiaries to make a voluntary choice to enroll or disenroll from the Participating Plan at any time. Prior to the effective date of their enrollment, individuals who would be passively enrolled will have the opportunity to opt out and will receive sufficient notice and information with which to do so, as further detailed in Appendix 7. Disenrollment from Participating Plans CICOs and transfers between Participating Plans enrollment from one CICO to a different CICO shall be allowed on a month-month- to-month basis any time during the year; however, coverage for these individuals will continue through the end of the month. CMS and DMAS the State will monitor enrollments and disenrollments for both evaluation purposes and for compliance with applicable marketing and enrollment laws, regulations and CMS policies, and for the purposes of identifying any inappropriate or illegal marketing practices. As part of this analysis, CMS and DMAS the State will monitor any unusual shifts in enrollment by individuals identified for passive enrollment Passive Enrollment into a particular Participating Plan CICO to a Medicare Advantage plan operated by the same parent organization. If those shifts appear to be due to inappropriate or illegal marketing practices, CMS and DMAS the State may issue corrective action. Any illegal marketing practices will be referred to appropriate agencies for investigation. As mutually agreed upon, and as discussed further in Appendix 7 and the threeThree-way contractWay Contract, CMS and DMAS the State will utilize an independent third party entity to entityto facilitate all enrollments into the Participating PlansCICOs. Participating Plan CICO enrollments, transfersincluding enrollment from one CICO to a different CICO, and opt-outs shall become effective on the same day for both Medicare and Medicaid (the first day of the following month). For those who lose Medicaid eligibility during the month, coverage and Federal financial participation will continue through the end of that month.

Enrollment and Disenrollment Processes. Under passive enrollment, eligible Eligible individuals will be notified of their right to select among contracted Participating ICDS Plans no fewer than sixty (60) days prior to the effective date of enrollment, and will have the opportunity to opt out until the last day of the month prior to the effective date of enrollment. When no active choice has been made, enrollment into a Participating an ICDS Plan may be conducted using a seamless, passive enrollment process that provides the opportunity for beneficiaries to make a voluntary choice to enroll or disenroll from the Participating ICDS Plan at any time. Prior to the effective date of their enrollment, individuals who would be passively enrolled will have the opportunity to opt opt-out and will receive sufficient notice and information with which to do so, as further detailed in Appendix 7. Disenrollment from Participating ICDS Plans and transfers between Participating ICDS Plans shall be allowed on a month-to-month basis any time during the year; however, coverage for these individuals will continue through the end of the month. CMS and DMAS the State will monitor enrollments and disenrollments for both evaluation purposes and for compliance with applicable marketing and enrollment laws, laws regulations and CMS policies, for the purposes of identifying any inappropriate or illegal marketing practices. As part of this analysis, CMS and DMAS the State will monitor any unusual shifts in enrollment by individuals identified for passive enrollment into a particular Participating Plan ICDS plan to a Medicare Advantage plan operated by the same parent organization. If those shifts appear to be due to inappropriate or illegal marketing practices, CMS and DMAS the State may issue corrective actiondiscontinue further passive enrollment into an ICDS plan. Any illegal marketing practices will be referred to appropriate agencies for investigation. As mutually agreed upon, and as discussed further in Appendix 7 and the three-way contract, CMS and DMAS the State will utilize an independent third party entity to facilitate all enrollments enrollment into the Participating ICDS Plans. Participating ICDS Plan enrollments, transfers, transfers and opt-outs shall become effective on the same day for both Medicare and Medicaid (the first day of the following month). For those who lose Medicaid eligibility during the month, coverage and Federal financial participation will continue through the end of that month.